Department of Biomedical Informatics, Columbia University, New York, New York, United States.
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States.
Appl Clin Inform. 2019 Jan;10(1):40-50. doi: 10.1055/s-0038-1676971. Epub 2019 Jan 16.
Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use.
To examine predictors of versus portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance.
This subgroup analysis includes 146 intervention-arm participants from a pragmatic randomized controlled trial of an inpatient portal. The participants received free access to an iPad and inpatient portal while hospitalized on medical and surgical cardiac units, together with hands-on help using them. We used logistic regression to identify characteristics predictive of use.
More technology experience (adjusted odds ratio [OR] = 5.39, = 0.049), less severe illness (adjusted OR = 2.07, = 0.077), and private insurance (adjusted OR = 2.25, = 0.043) predicted use, with a predictive performance (area under the curve) of 65.6%. No significant differences in age, gender, race, ethnicity, level of education, employment status, or patient activation existed between the and users in bivariate analyses. Significantly more users noticed medical errors during their hospital stay.
Portal use was not associated with several sociodemographic characteristics previously found to limit use in the inpatient setting. However, limited technology experience and high illness severity were still barriers to use. Future work should explore additional strategies, such as enrolling health care proxies and improving usability, to reduce potential disparities in portal use.
包括少数民族和老年人在内的弱势群体使用患者门户的频率低于相对更具优势的人群。获得和使用技术的机会有限是造成这些差异的原因。免费获得设备、互联网和技术支持可能消除使用门户方面的差异。
调查在获得免费 iPad、互联网和技术支持的住院患者中，预测 与 门户使用的因素。
这是一项关于住院患者门户的实用性随机对照试验的亚组分析，共纳入 146 名干预组参与者。这些患者在接受心脏科和外科的住院治疗时，获得了免费的 iPad 和住院门户使用权，同时还有使用这些设备的实操帮助。我们使用逻辑回归来确定预测 使用的特征。
更多的技术经验（调整后的优势比 [OR] = 5.39， = 0.049）、较轻的疾病严重程度（调整后的 OR = 2.07， = 0.077）和私人保险（调整后的 OR = 2.25， = 0.043）预测了 的使用，预测性能（曲线下面积）为 65.6%。在单变量分析中， 与 用户在年龄、性别、种族、民族、教育程度、就业状况或患者激活程度方面没有显著差异。显著更多的 用户在住院期间注意到医疗错误。
门户的使用与之前在住院环境中发现的限制使用的几个社会人口学特征无关。然而，有限的技术经验和较高的疾病严重程度仍然是 使用的障碍。未来的工作应该探索其他策略，例如招募医疗保健代理人和提高可用性，以减少门户使用方面的潜在差异。
